bs_bs_banner
Predictive accuracy of PSAD
has been known to influence PCa incidence.6 Obesity is commonly associated with hyperinsulinism. Elevated insulin and insulin-like growth factor-1 levels have been associated with an increased risk of PCa. Leptin, a polypeptide hormone produced by adipocytes, have been associated with larger prostate volume and higher grade, and more advanced PCa. In addition, low levels of high-density lipoprotein were found to be a risk factor of PCa. Therefore, obese men might be susceptible to PCa, because they are more likely to have metabolic syndrome. Unfortunately, detailed information about the aforementioned factors except for obesity was not available in this study. In future, I hope that a clear link between PCa detection and each factor can be shown in multivariable models of randomized trials. As a result, the inclusion of these independent factors in addition to BMI, PSA, PSA density and digital rectal examination into new indication criteria for biopsy will lead to improve the accuracy of PCa detection. Shinji Urakami M.D., Ph.D. Department of Urology, Toranomon Hospital, Tokyo, Japan [email protected]
Conflict of interest None declared.
References 1 Masuda H, Kagawa M, Kawakami S et al. Body mass index influences prostate cancer risk at biopsy in Japanese men. Int. J. Urol. 2013; 20: 701–7. 2 Lee SE, Hong SK, Park HZ et al. Higher body mass index is associated with lower risk of prostate cancer detection via multi (≥ 12)-core prostate biopsy in Korean men. Urology 2010; 76: 1063–6. 3 Oh JJ, Jeong SJ, Lee BK et al. Does obesity affect the accuracy of prostate-specific antigen (PSA) for predicting prostate cancer among men undergoing prostate biopsy. BJU Int. 2013; 112: E265–71. 4 Kim JH, Doo SW, Yang WJ et al. Impact of obesity on the predictive accuracy of prostate-specific antigen density and prostate-specific antigen in native Korean men undergoing prostate biopsy. Int. J. Urol. 2014; 21: 987–90. 5 Endogenous Hormones and Prostate Cancer Collaborative Group, Roddam AW, Allen NE, Appleby P, Key TJ. Endogenous sex hormones and prostate cancer: a collaborative analysis of 18 prospective studies. J. Natl. Cancer Inst. 2008; 100: 170–83. 6 Bhindi B, Locke J, Alibhai SM et al. Dissecting the association between metabolic syndrome and prostate cancer risk: analysis of a large clinical cohort. Eur. Urol. 2014; pii: S0302-2838(14)00125-0.
DOI: 10.1111/iju.12514
Editorial Comment Editorial Comment from Dr Simonato and Dr Romagnoli to Impact of obesity on the predictive accuracy of prostate-specific antigen density and prostate-specific antigen in native Korean men undergoing prostate biopsy Prostate-specific antigen (PSA) and its derivatives still remains the main tool for the early detection of prostate cancer while new markers and imaging techniques are tested to avoid unnecessary prostate biopsies and diagnostic delays. The problem is even more evident in obese men in which some studies have suggested a “schizophrenic” behavior of total PSA. On the one hand, a high value of body mass index is associated with lower serum total PSA levels as a result of hemodilution. On the other hand, the increase of weight is associated with a larger prostate and with higher values of total PSA.1,2 In the present article, the authors continue their investigation of obesity’s impact on the detection of prostate cancer.3 This large study of 1182 consecutive patients shows a difference in the positive biopsy rate in obese men and stronger statistical evidence of a high frequency of Gleason sum 7–10, which might justify a more aggressive diagnostic approach in obese men as an earlier prostate biopsy (lower PSA values), and an increase in the number of bioptic samples according to the greater volume of the prostate. As Banez et al., the authors did not find a difference in the ability of PSA to predict cancer-positive biopsy in relation to obesity, so they investigated the PSA density (PSAD). Their results suggest the PSAD as an interesting tool in the early diagnosis of prostate cancer in obese men, but some issues still arose:
• The possible error in the determination of the ultrasound prostate volume, which can significantly distort the PSAD. © 2014 The Japanese Urological Association
• The different relationship with age between the increase of the PSA and the increase of the size of the gland. • The PSAD cut-off: the authors suggested a reduction of the arbitrary cut-off value of PSAD on the evidence of their results correctly, but the criteria for reduction are uncertain and further studies are required. Unfortunately, as the authors said, the Western and Asia–Oceania criteria for obesity are different. I hope that similar studies will be carried out more often on the Caucasian population. Alchiede Simonato M.D. and Andrea Romagnoli M.D. Department of Urology, University of Genoa, IRCSS San Martino – IST, Genoa, Italy [email protected] DOI: 10.1111/iju.12524
Conflict of interest None declared.
References 1 Lee S, Min HG, Choi SH et al. Central obesity as a risk factor for prostatic hyperplasia. Obesity (Silver Spring) 2006; 14: 172–9. 2 Parsons JK, Carter HB, Partin AW et al. Metabolic factors associated with benign prostatic hyperplasia. J. Clin. Endocrinol. Metab. 2006; 91: 2562–8. 3 Kim JH, Doo SW, Yang WJ et al. Impact of obesity on the predictive accuracy of prostate-specific antigen density and prostate-specific antigen in native Korean men undergoing prostate biopsy. Int. J. Urol. 2014; 21: 987–90.
991
Predictive accuracy of PSAD
has been known to influence PCa incidence.6 Obesity is commonly associated with hyperinsulinism. Elevated insulin and insulin-like growth factor-1 levels have been associated with an increased risk of PCa. Leptin, a polypeptide hormone produced by adipocytes, have been associated with larger prostate volume and higher grade, and more advanced PCa. In addition, low levels of high-density lipoprotein were found to be a risk factor of PCa. Therefore, obese men might be susceptible to PCa, because they are more likely to have metabolic syndrome. Unfortunately, detailed information about the aforementioned factors except for obesity was not available in this study. In future, I hope that a clear link between PCa detection and each factor can be shown in multivariable models of randomized trials. As a result, the inclusion of these independent factors in addition to BMI, PSA, PSA density and digital rectal examination into new indication criteria for biopsy will lead to improve the accuracy of PCa detection. Shinji Urakami M.D., Ph.D. Department of Urology, Toranomon Hospital, Tokyo, Japan [email protected]
Conflict of interest None declared.
References 1 Masuda H, Kagawa M, Kawakami S et al. Body mass index influences prostate cancer risk at biopsy in Japanese men. Int. J. Urol. 2013; 20: 701–7. 2 Lee SE, Hong SK, Park HZ et al. Higher body mass index is associated with lower risk of prostate cancer detection via multi (≥ 12)-core prostate biopsy in Korean men. Urology 2010; 76: 1063–6. 3 Oh JJ, Jeong SJ, Lee BK et al. Does obesity affect the accuracy of prostate-specific antigen (PSA) for predicting prostate cancer among men undergoing prostate biopsy. BJU Int. 2013; 112: E265–71. 4 Kim JH, Doo SW, Yang WJ et al. Impact of obesity on the predictive accuracy of prostate-specific antigen density and prostate-specific antigen in native Korean men undergoing prostate biopsy. Int. J. Urol. 2014; 21: 987–90. 5 Endogenous Hormones and Prostate Cancer Collaborative Group, Roddam AW, Allen NE, Appleby P, Key TJ. Endogenous sex hormones and prostate cancer: a collaborative analysis of 18 prospective studies. J. Natl. Cancer Inst. 2008; 100: 170–83. 6 Bhindi B, Locke J, Alibhai SM et al. Dissecting the association between metabolic syndrome and prostate cancer risk: analysis of a large clinical cohort. Eur. Urol. 2014; pii: S0302-2838(14)00125-0.
DOI: 10.1111/iju.12514
Editorial Comment Editorial Comment from Dr Simonato and Dr Romagnoli to Impact of obesity on the predictive accuracy of prostate-specific antigen density and prostate-specific antigen in native Korean men undergoing prostate biopsy Prostate-specific antigen (PSA) and its derivatives still remains the main tool for the early detection of prostate cancer while new markers and imaging techniques are tested to avoid unnecessary prostate biopsies and diagnostic delays. The problem is even more evident in obese men in which some studies have suggested a “schizophrenic” behavior of total PSA. On the one hand, a high value of body mass index is associated with lower serum total PSA levels as a result of hemodilution. On the other hand, the increase of weight is associated with a larger prostate and with higher values of total PSA.1,2 In the present article, the authors continue their investigation of obesity’s impact on the detection of prostate cancer.3 This large study of 1182 consecutive patients shows a difference in the positive biopsy rate in obese men and stronger statistical evidence of a high frequency of Gleason sum 7–10, which might justify a more aggressive diagnostic approach in obese men as an earlier prostate biopsy (lower PSA values), and an increase in the number of bioptic samples according to the greater volume of the prostate. As Banez et al., the authors did not find a difference in the ability of PSA to predict cancer-positive biopsy in relation to obesity, so they investigated the PSA density (PSAD). Their results suggest the PSAD as an interesting tool in the early diagnosis of prostate cancer in obese men, but some issues still arose:
• The possible error in the determination of the ultrasound prostate volume, which can significantly distort the PSAD. © 2014 The Japanese Urological Association
• The different relationship with age between the increase of the PSA and the increase of the size of the gland. • The PSAD cut-off: the authors suggested a reduction of the arbitrary cut-off value of PSAD on the evidence of their results correctly, but the criteria for reduction are uncertain and further studies are required. Unfortunately, as the authors said, the Western and Asia–Oceania criteria for obesity are different. I hope that similar studies will be carried out more often on the Caucasian population. Alchiede Simonato M.D. and Andrea Romagnoli M.D. Department of Urology, University of Genoa, IRCSS San Martino – IST, Genoa, Italy [email protected] DOI: 10.1111/iju.12524
Conflict of interest None declared.
References 1 Lee S, Min HG, Choi SH et al. Central obesity as a risk factor for prostatic hyperplasia. Obesity (Silver Spring) 2006; 14: 172–9. 2 Parsons JK, Carter HB, Partin AW et al. Metabolic factors associated with benign prostatic hyperplasia. J. Clin. Endocrinol. Metab. 2006; 91: 2562–8. 3 Kim JH, Doo SW, Yang WJ et al. Impact of obesity on the predictive accuracy of prostate-specific antigen density and prostate-specific antigen in native Korean men undergoing prostate biopsy. Int. J. Urol. 2014; 21: 987–90.
991
